葡萄糖-6-磷酸脱氢酶缺乏症患者血糖监测指标的选择及应用

The selection and application of blood glucose monitoring indicators in patients with glucose-6 phosphatase deficiency

目的探讨糖化清蛋白(GA)、糖化血清蛋白(GSP)、糖化血红蛋白(HbA1c)与GA/HbA1c比值等血糖监测指标在葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症患者中的应用价值。方法选取2014年3月至2018年1月于该院就诊的患者或进行体检的健康人共372例,其中纳入G6PD正常组的共234例,包括健康体检者146例(健康组)和糖尿病患者88例(糖尿病组);纳入G6PD缺乏症组的共138例,又根据是否合并糖尿病分为G6PD缺乏症未合并糖尿病组(104例)及G6PD缺乏症合并糖尿病组(34例)。检测各组人群的空腹血糖(FPG)、GA、GSP、HbA1c水平并计算GA/HbA1c比值,然后进行组间比较,分析GA、GSP、HbA1c水平及GA/HbA1c比值与FPG的相关性。结果G6PD缺乏症未合并糖尿病组与健康组、G6PD缺乏症合并糖尿病组与糖尿病组比较,HbA1c水平均较低(P<0.05),GA/HbA1c比值均较高(P<0.05),而GA和GSP水平差异无统计学意义(P>0.05)。G6PD缺乏症组与G6PD正常组相比,HbA1c水平、GA/HbA1c比值差异均有统计学意义(P<0.05),而GA及GSP水平差异无统计学意义(P>0.05)。G6PD正常组中,FPG与GA、GSP、HbA1c及GA/HbA1c比值均呈正相关(r=0.426、0.378、0.572、0.458,P<0.05)。G6PD缺乏症组中,FPG与GA、GSP呈正相关(r=0.373、0.480,P<0.05),而FPG与HbA1c、GA/HbA1c比值均无相关性(r=0.262、0.192,P>0.05)。结论G6PD缺乏会导致患者HbA1c水平偏低,而GA和GSP水平不受影响,对于G6PD缺乏的患者,GA和GSP水平能更准确地反映其血糖控制水平,是其血糖监测的优选指标。

Objective To compare the clinical application values of glycated albumin(GA),glycated serum protein(GSP),glycated hemoglobin(HbA1c)and GA/HbA1c ratio in patients with glucose 6 phosphatase(G6PD)deficiency.Methods From March 2014 to January 2018,a total of 372 people were enrolled in the study including patients and healthy people who underwent physical examination in the hospital.Among those people,234 people were enrolled as the normal G6PD group,including 146 healthy people(the healthy group)and 88 diabetic patients(the diabetic group).A total of 138 patients with G6PD deficiency were enrolled as the G6PD deficiency group,and divided into the G6PD deficiency without diabetes group(104 cases)and the G6PD deficiency with diabetes group(34 cases).Fasting blood glucose(FPG),GA,GSP,HbA1c levels were detected,and GA/HbA1c ratio was calculated.Then the correlation between GA,GSP,HbA1c levels,GA/HbA1c ratio and FPG was analyzed.Results Both compared between the G6PD deficiency without diabetes and the healthy group,the G6PD deficiency with diabetes and the diabetes group,HbA1c levels were lower(P<0.05),GA/HbA1c ratio were higher(P<0.05)in the previous group,but GA and GSP levels were not significantly different(P>0.05).Compared with the G6PD normal group,the G6PD deficiency group had statistically significant differences in HbA1c levels and the GA/HbA1c ratio(P<0.05),while the differences in GA and GSP levels were not statistically significant(P>0.05).In the G6PD normal group,FPG was positively correlated with GA,GSP,HbA1c and the ratio of GA/HbA1c(r=0.426,0.378,0.572,0.458,P<0.05).In the G6PD deficiency group,FPG was positively correlated with GA and GSP(r=0.373,0.480,P<0.05),while FPG was not correlated with HbA1c and GA/HbA1c ratios(r=0.262,0.192,P>0.05).Conclusion G6PD deficiency can lead to low HbA1c levels in patients,while GA and GSP levels are not affected.For patients with G6PD deficiency,GA and GSP levels can reflect the situation of their blood glucose control more acurately and are the preferred indicators for blood glucose monitoring.